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Article: Is automatic mode switching effective for atrial arrhythmias occurring at different rates? A study of the efficacy of automatic mode and rate switching to simulated atrial arrhythmias by chest wall stimulation

TitleIs automatic mode switching effective for atrial arrhythmias occurring at different rates? A study of the efficacy of automatic mode and rate switching to simulated atrial arrhythmias by chest wall stimulation
Authors
Issue Date2000
PublisherWiley-Blackwell Publishing, Inc. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0147-8389&site=1
Citation
Pace - Pacing And Clinical Electrophysiology, 2000, v. 23 n. 5, p. 824-831 How to Cite?
AbstractAutomatic mode switching (AMS) is a useful means to avoid rapid ventricular response during atrial fibrillation (AF), but AMS cannot occur if the detected atrial rate during AF is below the mode switching criteria. This may be the result of antiarrhythmic medications, or when the atrial events fall within the atrial blanking period, or if the atrial amplitudes during AF are too small to be sensed. We hypothesize that the addition of an automatic rate switching (ARS) algorithm may complement AMS response during AF with different detected atrial rates. We studied the Marathon DDDR pacemaker (Model 294-09, Intermedics Inc.) with the AMS and ARS algorithms that are independently programmable but can also operate in combination. AF sensed above the AMS rate (160 beats/min) will lead to VDIR pacing, whereas AF below AMS rate will be tracked at an interim rate as dictate by the ARS, at a ventricular response that is 20 beats/min above the sensor indicated rate. Atrial tachyarrhythmias were simulated by chest wall stimulation (CWS). CWS was applied to 33 patients (16 men, 17 women, mean age 69 ± 11 years) with a Marathon DDDR pacemaker using an external pacer to simulate AF occurring at two rate levels: above the AMS rate (programmed at 160 beats/min) at 180 beats/min and below the AMS rate at 120 beats/min. The maximum, minimum, and mean ventricular rates during CWS in DDDR mode with AMS alone, ARS alone, and their combination were compared. During CWS at 120 beats/min, the AMS plus ARS setting showed a mean ventricular rate of 79 ± 3 beats/min and 124 ± 14 beats/min in the AMS setting alone (P < 0.01). With CWS at 180 beats/min, the mean ventricular rate in the AMS plus ARS setting compared to the AMS setting alone was not significantly different. However, the variation in ventricular pacing rate was 7 ± 14 beats/min in the AMS plus ARS setting and 40 ± 42 beats/min in the AMS setting (P < 0.05). In conclusion, AMS is effective for simulated atrial tachyarrhythmias sensed above the AMS rate. Combined AMS with ARS is useful to handle simulated atrial tachyarrhythmia at a slower rate and to avoid rate fluctuation during AMS. There is also a possibility that this can be applied to the naturally occurring atrial tachyarrhythmias.
Persistent Identifierhttp://hdl.handle.net/10722/161623
ISSN
2015 Impact Factor: 1.156
2015 SCImago Journal Rankings: 0.662
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLeung, SKen_US
dc.contributor.authorLau, CPen_US
dc.contributor.authorLam, CTFen_US
dc.contributor.authorTse, HFen_US
dc.contributor.authorLee, Ken_US
dc.contributor.authorChan, WKen_US
dc.contributor.authorLeung, Zen_US
dc.date.accessioned2012-09-05T05:13:09Z-
dc.date.available2012-09-05T05:13:09Z-
dc.date.issued2000en_US
dc.identifier.citationPace - Pacing And Clinical Electrophysiology, 2000, v. 23 n. 5, p. 824-831en_US
dc.identifier.issn0147-8389en_US
dc.identifier.urihttp://hdl.handle.net/10722/161623-
dc.description.abstractAutomatic mode switching (AMS) is a useful means to avoid rapid ventricular response during atrial fibrillation (AF), but AMS cannot occur if the detected atrial rate during AF is below the mode switching criteria. This may be the result of antiarrhythmic medications, or when the atrial events fall within the atrial blanking period, or if the atrial amplitudes during AF are too small to be sensed. We hypothesize that the addition of an automatic rate switching (ARS) algorithm may complement AMS response during AF with different detected atrial rates. We studied the Marathon DDDR pacemaker (Model 294-09, Intermedics Inc.) with the AMS and ARS algorithms that are independently programmable but can also operate in combination. AF sensed above the AMS rate (160 beats/min) will lead to VDIR pacing, whereas AF below AMS rate will be tracked at an interim rate as dictate by the ARS, at a ventricular response that is 20 beats/min above the sensor indicated rate. Atrial tachyarrhythmias were simulated by chest wall stimulation (CWS). CWS was applied to 33 patients (16 men, 17 women, mean age 69 ± 11 years) with a Marathon DDDR pacemaker using an external pacer to simulate AF occurring at two rate levels: above the AMS rate (programmed at 160 beats/min) at 180 beats/min and below the AMS rate at 120 beats/min. The maximum, minimum, and mean ventricular rates during CWS in DDDR mode with AMS alone, ARS alone, and their combination were compared. During CWS at 120 beats/min, the AMS plus ARS setting showed a mean ventricular rate of 79 ± 3 beats/min and 124 ± 14 beats/min in the AMS setting alone (P < 0.01). With CWS at 180 beats/min, the mean ventricular rate in the AMS plus ARS setting compared to the AMS setting alone was not significantly different. However, the variation in ventricular pacing rate was 7 ± 14 beats/min in the AMS plus ARS setting and 40 ± 42 beats/min in the AMS setting (P < 0.05). In conclusion, AMS is effective for simulated atrial tachyarrhythmias sensed above the AMS rate. Combined AMS with ARS is useful to handle simulated atrial tachyarrhythmia at a slower rate and to avoid rate fluctuation during AMS. There is also a possibility that this can be applied to the naturally occurring atrial tachyarrhythmias.en_US
dc.languageengen_US
dc.publisherWiley-Blackwell Publishing, Inc. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0147-8389&site=1en_US
dc.relation.ispartofPACE - Pacing and Clinical Electrophysiologyen_US
dc.subject.meshAgeden_US
dc.subject.meshAlgorithmsen_US
dc.subject.meshAtrial Fibrillation - Physiopathology - Therapyen_US
dc.subject.meshCardiac Pacing, Artificialen_US
dc.subject.meshElectrocardiographyen_US
dc.subject.meshFemaleen_US
dc.subject.meshHeart Block - Physiopathology - Therapyen_US
dc.subject.meshHeart Rate - Physiologyen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPacemaker, Artificialen_US
dc.subject.meshSick Sinus Syndrome - Physiopathology - Therapyen_US
dc.subject.meshSoftwareen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleIs automatic mode switching effective for atrial arrhythmias occurring at different rates? A study of the efficacy of automatic mode and rate switching to simulated atrial arrhythmias by chest wall stimulationen_US
dc.typeArticleen_US
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_US
dc.identifier.authorityTse, HF=rp00428en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1111/j.1540-8159.2000.tb00850.x-
dc.identifier.pmid10833701-
dc.identifier.scopuseid_2-s2.0-0000340954en_US
dc.identifier.hkuros57052-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0000340954&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume23en_US
dc.identifier.issue5en_US
dc.identifier.spage824en_US
dc.identifier.epage831en_US
dc.identifier.isiWOS:000087165700004-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridLeung, SK=7202044902en_US
dc.identifier.scopusauthoridLau, CP=7401968501en_US
dc.identifier.scopusauthoridLam, CTF=7402990956en_US
dc.identifier.scopusauthoridTse, HF=7006070805en_US
dc.identifier.scopusauthoridLee, K=8624893900en_US
dc.identifier.scopusauthoridChan, WK=7403918940en_US
dc.identifier.scopusauthoridLeung, Z=6506620133en_US
revieweditem.identifier.hkuros54845-

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